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Table 3 Bacterial co-infection reported among severe cases of A(H1N1)pdm09 admitted in ICUs (n = 16)

From: The role of pneumonia and secondary bacterial infection in fatal and serious outcomes of pandemic influenza a(H1N1)pdm09

Author and year Study type Study population Case severity Antiviralsa
n/N (%) any
n/N (%) 48 h
Antibiotics†
n/N (%) pre
n/N (%) on
n/N (%) during admission
Any positive bacterial growth Number (%) patients with S.pneumoniae and site of isolation Number (%) with bacterial pneumonia
- Method
- Diff/no diff
ICU - ECMO Mechanical Ventilation Deaths
Miller (2010) [36]
Utah, USA
5/09–6/09
Adults(16+)
Multicentre (4) case series (+ comparison with local resident population) / Adult (> 15 y) ICU admissions N = 47 47/47 (100)
- 0
13/47 (27.7)
IV = 11/47 (84.6)
8/47 (14) 47/47 (100.0)
- 45/47 (95.7)
44/47 (93.6)
- NS
6/47 (13) 0/47 (0) BC
0/47 (0) ET aspirate
0/47 (0) SC
0/47 (0) BAL fluid
43/47(91.5)
- CXR
- No diff
Rello [29] (2009)
Spain
6/09–7/09
Adults
Multicentre (20) case series (retrospective) / ICU adult admissions with ARF N = 32 32/32 (100)
- 0
24/32 (75.0)
- IV = 22/32 (91.7)
- NIV = 2/32 (8.3)
8/32 (25) 32/32 (100.0)
-NS
32/32 (100.0) 1/32 (3.1)
Secondary superinfection with Pseudomonas
aeruginosa were also documented in three patients (9.3).
1/32 (3.1) aspirate
0/32 (0) BC
1/32 (3.1)
respiratory culture
ANZ ECMO [34] (2009)
Australia and New Zealand
6/09–8/09
All ages
Multicentre (15) cohort study (retrospective) / All ages ICU admission with ARDS treated with ECMO
Includes probable casesa
N = 68 68/68 (100)
- 68/68 (100)
68/68 (100) 14/68 (20.6) 64/68 (94.1)
- NS
NR 19/68 (28) 10/68 (14.7) [respiratory secretion/BC] 66/68 (97.1)
CXR/CT
No diff
Estenssoro (2010) [5]
Argentina
6/09–9/09
Adults(15+)
Multicentre (35) inception cohort study (prospective & retrospective) / adult (≥ 15 years) ICU admissions with ILI & ARF requiring MV
Includes probable casesa
N = 337 337/337 (100) 337/337 (100)
NIV = 64/337 (19.0)
156/337 (46.3) 328/336 (98)
- NS
337/337 (100)
- NS
28/337 (8.3) 28 /337 [NS]
8.3
80/337 (23.7)
CXR/CT
Diff
Nin [31] (2011)
Chile, Uruguay
6/09–9/09
Multicenter (10) case series (> 18 yrs) (retrospective and prospective) / Respiratory failure requiring ICU mechanical ventilation **
(confirmed = 77/ 96)
Includes probable casesa
N = 96 96/96 (100)
13/96 (13.5)
96/96 (100)
NIV = 10/96 (10.4)
IV = 86/96 (89.6)
Prone ventilation = 44 /96 (45.8)HFOV = 10/96 (10.4)
48/96 (50) 84/96 (87.5)
- NS
91/96 (94.8)
- NS
8/96 (8) NR 32/96 (33.3, 8 within first week of admission)
- Purulent sputum, significant growth of pathogen in ET aspirate
- diff
Koegelenberg (2010) [30]
South Africa
8/09–9/09
Adults(18+)
Single-centre case series (prospective)/Adult (> = 18 y) ICU admissions with ARF requiring MV N = 19 19/19 (100)
- NR
19/19 (100)
- NIV = 2/19 (10.5)
13/19 (68.4) 19/19 (100)
- 14 (73.7)
NR 0/19 (19) 0/19 (0) BC
0/19 (0) ET aspirates
0/19 (0) other NS
0/19 (0)
(10 cases of nosocomial infection (> = 48 h admission)
- CXR
Martin-Loeches [28] (2010)
Spain
1st case - 12/09
Adults (16+)
Multicentre (148) case series (prospective) /Adult (> = 15 y) ICU admissions with ARF N = 645 645/645 (100) NR
- IV = 389/645 (60.3)
112/645 (17.4) 620/645 (96.1)
- NS
645/645 (100)
- NS
113/645 (17.5) 62 /645 (9.6)
site NS
Cultures routinely every day
113/645 (17.5)
- CXR + pos culture
- diff
Rice [39] (2012)
US
4/09–4/10
Multicenter (35) case series (retrospective and prospective) / Critically ill cases (> 13 years) admitted to adult ICU’s (Confirmed = 424/683, 62%)
Includes probable casesa
N = 683 683/683 (100) 231/683 (33.8)
- IV = 175/683 (75.8)
- NIV = 56/683 (24.2)
309/683 (45.2) 683/683 (100)
-NS
NR Total 154/683 (22.5)
Sputum specimen
84/683 (12.3)
Bacteraemia 50 (7.3)
Both 20 (2.9)
10/683 (1.5) BC 207/683 (30.3) clinical coinfection, non-diff
CDC [27] Patients at a tertiary care hospital in Michigan N = 10 10/10 (100) 10/10 (100) 3/10 (30%) 10/10 (100) 10/10 (100) NR NR NR
Kim [32] ICU in 28 Hospitals in SK 245 245/245 (100) 162/245 (100) 99/245 (40.4) 103/245 (42) 243/245 (99.2) 91/245 (37.1) 0/245 (0) 91/245 (37.1)
Malato [35] ICU in one hosiptal 24 24/24 (100) 6/24 (25) 4/24 (16.7) 20/20 (100) NR 6/24 (25) 0/24 (0) 6/24 (25)
Kumar [33] (2009)
Canada
4/09–8/09
All ages
Multicentre (38) cohort study (prospective & retrospective) /All age critically ill patients = ICU & requiring MV or IV medication or ≥ 60% inspired O2 fraction
Includes probable casesa
N = 168 168/168 (100)
- 7/168 (4.2)
136/168 (81.0)
- IV = 128/168 (94.1)
- HFOV = 20/168 (14.7)
29/168 (17.3) NR NR   5/168 (2.9) site NS 54/168 (32.1) possible at presentation; 41/168 (24.4) clinically dx cases following ICU admission
- CXR + culture /clinical opinion
Roch [26] ARDS cases in ICU N = 18 18/18 (100) 10/18 (100) 10/10 (100) NR NR 0/18 (0) 0/18 (0) 0/18 (0)
Lucker [37] One hospital ICU, medical charts reviewed 14 14/14 (100) 10/14 (71.4) 2/14 (14.3) 14/14 (100) 13/14 (92.9) 6/14 (42.8)
Of ICU cases
0/14 (0) 6/14 (42.9)
Leen [38] 22 bed ICU in one hospital N = 31 31/31 (100)   3/31 (10) NR NR NR NR 10/31 (32.2)
Method not mentioned
Torres [40] Hospital in Chile. Includes probable casesa N = 11 11/11 (100) 11/11 (100) 0/11 (0) 11/11 (100) 7/11 (63.6) 1/11 (0.9)
Group A Streptococcus
Site NR
0/11 (0) 6/11 (54.5)
Non Diff
  1. Antibiotics: time started – “Pre” = started prior admission, “On” = started on admission, “During” = started during admission
  2. Diff Differentiated between bacterial pneumonia, viral pneumonia and ARDS
  3. No diff Did not differentiate between aetiology of abnormal chest imaging
  4. aH1N1 testing = 53 (77.9) PCR/viral culture, 8 (11.8) serologically diagnosed but flu A not typed [34]; probable cases not defined [31]; Probable: Flu A, not otherwise subtyped [39]